Polycystic Ovary Syndrome (eBook)

Dr. Azziz is President and member of the Board of Directors of the Society of Reproductive Surgeons and a past member of the Board of Directors of the American Society for Reproductive Medicine (ASRM) and The Society of Reproductive Endocrinologists. He is also a member of the Endocrine Society and The Society for Gynecologic Investigation, among others. He serves as Executive Director of the Androgen Excess Society, of which he is also a founding member.

Contents 6
Contributors 9
Chapter 1 Definition, Diagnosis, and Epidemiology of the Polycystic Ovary Syndrome 11
1. DEFINING PCOS: BASICS 11
2. SPECIFIC CRITERIA FOR PCOS 12
3. DIAGNOSIS OF PCOS 16
4. PREVALENCE OF PCOS 19
5. CONCLUSIONS 21
REFERENCES 22
Chapter 2 Clinical Evaluation of PCOS 26
1. FEATURES OF PCOS 26
2. DIFFERENTIAL DIAGNOSIS OF PCOS 28
3. EVALUATION FOR INSULIN RESISTANCE IN PCOS 30
4. SUMMARY 33
REFERENCES 33
Chapter 3 Genetics of PCOS 37
1. THE INHERITED BASIS OF PCOS AND ITS COMPONENT PHENOTYPES 37
2. THE CANDIDATE GENE APPROACH AS APPLIED TO PCOS GENETICS 38
3. EPIGENETICS: A NEW AVENUE IN PCOS GENETICS 47
4. CONCLUSIONS 48
REFERENCES 48
Chapter 4 Insulin Action in Polycystic Ovary Syndrome: In Vivo and In Vitro 51
1. INTRODUCTION 51
2. INSULIN ACTION IN PCOS 52
3. ANDROGENIC ACTIONS OF INSULIN IN PCOS 54
4. INSULIN ACTIONS AND OVULATORY DYSFUNCTION IN PCOS 62
5. CONCLUSIONS 67
6. FUTURE AVENUES OF INVESTIGATION 69
REFERENCES 70
Chapter 5 Ovarian Steroidogenic Abnormalities in PCOS 77
1. OVARIAN ANDROGEN AND ESTROGEN BIOSYNTHESIS 78
2. DYSREGULATED ESTROGEN BIOSYNTHESIS IN PCOS 80
3. DYSREGULATED ANDROGEN BIOSYNTHESIS IN PCOS 81
4. INCREASES IN CYP17 AND CYP11A1 GENE TRANSCRIPTION AND mRNA STABILITY IN PCOS 83
5. INSULIN SENSITIVITY AND THE PCOS OVARY 85
6. MITOGEN ACTIVATED PROTEIN KINASE SIGNALING AND ALTERED STEROID BIOSYNTHESIS IN PCOS 85
7. GENE EXPRESSION PROFILING AND CANDIDATE GENE ANALYSIS IN PCOS 86
8. PARACRINE AND AUTOCRINE REGULATORS THAT MAY IMPACT OVARIAN STEROID ABNORMALITIES AND FOLLICULAR GROWTH IN THE PCOS OVARY 88
9. SUMMARY 90
REFERENCES 90
Chapter 6 Role of Obesity and Adiposity in PCOS 93
1. PREVALENCE OF OBESITY IN PCOS 94
2. PATTERN AND IMPLICATIONS OF BODY FAT DISTRIBUTION IN WOMEN WITH PCOS 95
3. PATHOPHYSIOLOGY OF OBESITY ON THE HYPERANDROGENIC, OVULATORY, AND METABOLIC ALTERATIONS OF PCOS 96
4. SUMMARY AND PERSPECTIVES 104
REFERENCES 104
Chapter 7 Strategies for Ovulation Induction in the Management of Anovulatory Polycystic Ovary Syndrome 106
1. PCOS AND ANOVULATORY INFERTILITY: THE BASICS 106
2. LIFESTYLE AND WEIGHT LOSS IN PCOS 108
3. CC THERAPY 109
4. AROMATASE INHIBITORS 111
5. GONADOTROPIN THERAPY 111
6. SURGICAL OVULATION INDUCTION 112
7. THE ROLE OF METFORMIN AND OTHER INSULIN SENSITIZERS 114
8. IVF IN WOMEN WITH POLYCYSTIC OVARIES 117
9. IVM OF OOCYTES 119
10. SUMMARY 119
REFERENCES 120
Chapter 8 Long- Term Morbidity of PCOS 124
1. INTRODUCTION 124
2. PREVALENCE OF PRINCIPAL MORBIDITIES ASSOCIATED WITH PCOS 124
3. ESTIMATING THE ECONOMIC BURDEN OF PCOS 131
4. CONCLUSIONS 131
REFERENCES 132
Index 137